@article {10458, title = {Preputial reconstruction in hypospadias repair.}, journal = {J Pediatr Urol}, volume = {13}, year = {2017}, month = {2017 Feb}, pages = {102-109}, abstract = {

OBJECTIVE: In principle, the prepuce can be reconstructed during hypospadias repair, but the procedure has not gained wide acceptance and preputial reconstruction (PR) is surrounded by several controversies.

MATERIAL AND METHODS: A review is provided of the technique for PR, how PR combines with the other steps of hypospadias repair, the risks of complications related to the urethroplasty and specific to PR, and the results of PR with particular regard to the relevance for the patient and his family.

RESULTS: PR can be important for patients requiring hypospadias repair and their parents. It can be performed in almost all patients with distal hypospadias except perhaps those with the most asymmetrical prepuces or severe ventral skin deficiency. PR does not seem to increase urethroplasty complications, but combination of PR with tubularisation of the urethral plate urethroplasty seems to offer the best chance of success. Specific complications occur in around 8\% of patients and include partial or complete dehiscence of the prepuce and secondary phimosis. To prevent the latter, the reconstructed prepuce should be easily retractile at the end of surgery. Technical modifications can help to achieve this goal. Cosmetically, reconstructed prepuces are not fully normal, but the abnormality could be less important for a patient and his parents that the complete absence of the prepuce.

CONCLUSION: On the basis of the evidence summarised above, an algorithm for PR in patients with distal hypospadias is proposed. PR can be offered to the vast majority of distal hypospadias patients, although some modification of the technique for hypospadias repair can be required. Retractility of the reconstructed prepuce at the end of surgery seems paramount for final success.

}, issn = {1873-4898}, doi = {10.1016/j.jpurol.2016.07.018}, author = {Castagnetti, Marco and Bagnara, Vincenzo and Rigamonti, Waifro and Cimador, Marcello and Esposito, Ciro} } @article {8479, title = {Does Preputial Reconstruction Increase Complication Rate of Hypospadias Repair? 20-Year Systematic Review and Meta-Analysis.}, journal = {Front Pediatr}, volume = {4}, year = {2016}, month = {2016}, pages = {41}, abstract = {

INTRODUCTION: We performed a systematic review of the literature on preputial reconstruction (PR) during hypospadias repair to determine the cumulative risk of preputial skin complications and the influence of PR on urethroplasty complications, namely, fistula formation and overall reoperation rate of the repair.

MATERIALS AND METHODS: A systematic search of the literature published after 06/1995 was performed in 06/2015 using the keyword "hypospadias." Only studies on the outcome of PR in children, defined as dehiscence of the reconstructed prepuce or secondary phimosis needing circumcision, were selected. A meta-analysis of studies comparing PR vs. circumcision was performed for the outcomes "hypospadias fistula formation" and "reoperation rate."

RESULTS: Twenty studies were identified. Nineteen reported the outcome of PR in 2115 patients. Overall, 95\% (2016/2115) of patients undergoing PR had distal hypospadias. The cumulative rate of PR complications was 7.7\% (163/2115 patients), including 5.7\% (121/2115 patients) preputial dehiscences and 1.5\% (35/2117 reported patients) secondary phimoses needing circumcision. A meta-analysis of seven studies comparing patients undergoing PR vs. circumcision showed no increased risk of urethral fistula formation associated with PR, odds ratio (OR) (Mantel-Haenszel, Fixed effect, 95\% CI), 1.25 (0.80-1.97). Likewise, two studies comparing the overall reoperation rate did not show an increased risk of reoperation associated with PR, OR (Mantel-Haenszel, Random effect, 95\% CI), 1.27 (0.45-3.58).

CONCLUSION: PR carries an 8\% risk of specific complications (dehiscence of reconstructed prepuce or secondary phimosis needing circumcision), but does not seem to increase the risk of urethroplasty complications, and the overall reoperation rate of hypospadias repair.

}, issn = {2296-2360}, doi = {10.3389/fped.2016.00041}, author = {Castagnetti, Marco and Gnech, Michele and Angelini, Lorenzo and Rigamonti, Waifro and Bagnara, Vincenzo and Esposito, Ciro} }